ABSTRACT
The evaluation and management of fecal incontinence begins by obtaining a careful history which can provide insight into the nature of the problem and suggest possible causes and contributing factors. A relatively short history of fecal incontinence, often with urinary incontinence, which is associated with low back or perineal pain is suggestive of a neurologic disorder of the spinal cord or peripheral nerves. Patients with multiple sclerosis often have anal sphincter dysfunction which is not clinically manifest because of underlying constipation, which is characteristic of this disorder. Fecal impaction with overflow soiling should be the primary consideration in bedridden or physically immobilized patients with incontinence. The evaluation of fecal incontinence in children is quite different from that of adults with fecal soiling and is frequently obtained from a parent or guardian. Inquiry should also be made concerning the pattern and severity of fecal soiling. Diagnosis and treatment of fecal incontinence depends heavily upon careful history taking in all age groups.
